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1.
Recurso de Internet en Inglés, Español, Portugués | LIS - Localizador de Información en Salud | ID: lis-48460

RESUMEN

No Dia Mundial do Coração, a Organização Pan-Americana da Saúde (OPAS) destaca a importância da prevenção e do tratamento das doenças cardiovasculares – a principal causa de morte nas Américas, que tira dois milhões de vidas cada ano.


Asunto(s)
Américas , Enfermedades Cardiovasculares , Cardiopatías , Accidente Cerebrovascular
2.
Orv Hetil ; 162(40): 1601-1609, 2021 10 03.
Artículo en Húngaro | MEDLINE | ID: mdl-34601457

RESUMEN

Összefoglaló. A neurológiai betegek körében a dysphagia elofordulása gyakori, és több oka van. Az utóbbi évek kutatásai a közvetlen neurológiai kórokok (beleértve a gyakori stroke) szerepét is részletesen feltárták. Felismerték az ún. néma aspiráció jelentoségét: ez gyakran áll az (aspirációs) pneumonia hátterében, amely sokszor halálos szövodmény lehet. Az ún. poststroke pneumonia fogalma gyökeresen más értelmezésbe helyezte a stroke-ot követo tüdogyulladások megítélését, jellegzetessége alapján egyértelmuen a stroke közvetlen cerebralis hatásaként alakul ki. Egyértelmuvé vált a nyelészavar korai felismerésének és ellátásának szükségessége. A stroke-betegek megfelelo tápláltsági állapota az eredményes rehabilitációnak, a szövodményszám csökkentésének, a rövidebb kórházi kezelésnek, az alacsonyabb mortalitásnak a záloga. A dysphagia a betegség kimenetelének független elorejelzoje lehet, különösen az elso három hónapban. A nyelészavar malnutritióval, kiszáradással és a kórházi tartózkodás hosszabb idotartamával jár együtt, emeli a gyógyszerköltségeket. A stroke-beteg ellátásának egyik elso eleme a dysphagia szurése. Táplálásterápiára akkor szorul a stroke-beteg, amikor magas a kóros tápláltsági állapot kialakulásának kockázata, és per os táplálással nem fedezheto biztonságosan a megfelelo energia-, tápanyag- és folyadékbevitel. A táplálásterápia módját, eszközeit, az energia- és tápanyagbeviteli célértékeket az orvos határozza meg, az alapbetegség súlyosságától, a társbetegségektol és a laborértékektol függoen. Az étrend minden esetben individuális és progresszív, azaz alkalmazkodik a beteg állapotához és annak változásához. A dietetikus feladata a megfelelo diéta összeállítása mellett a beteg, a hozzátartozó és a kezeloszemélyzet oktatása, az állapot követése, a beteg tápláltsági állapotának, tápanyagbeviteli értékeinek gyakori elemzése, szükség esetén tápszerek ajánlása. Orv Hetil. 2021; 162(40): 1601-1609. Summary. Among neurological patients, the incidence of dysphagia is common and has several causes. Research in recent years has explored the role of direct neurological pathogens (including frequent strokes). The frequency of 'silent aspiration', which often underlies (aspirational) pneumonia and can be a fatal complication, has been recently discovered. The concept of 'post-stroke pneumonia' has drastically changed the assessment of post-stroke pneumonia. Based on its characteristics, it clearly develops as a direct cerebral effect of stroke. The need for early detection and early care of swallowing disorder has become clear. Adequate nutritional status of stroke patients is the key to successful rehabilitation, reduction of complications, shorter hospitalization, and lower mortality. Dysphagia can be an independent predictor of disease outcome, especially in the first three months. Swallowing disorder is associated with malnutrition, dehydration and longer lengths of hospital stay, increasing drug costs. One of the first elements in the care of a stroke patient is screening for dysphagia. The stroke patient needs nutritional therapy when the risk for abnormal nutritional condition is high or if the condition is already present, or when oral nutrition does not safely cover adequate energy, nutrient and fluid intake. The method and means of nutritional therapy, the goals of energy and nutrient intake are determined by the doctor, depending on the severity of the underlying disease, comorbidities and laboratory values.The diet is individual and progressive in each case. The dietitian's task is not only to compile a proper diet, but also to educate the patients and relatives. The dietitian is responsible for monitoring the patient's nutritional status. Orv Hetil. 2021; 162(40): 1601-1609.


Asunto(s)
Trastornos de Deglución , Terapia Nutricional , Accidente Cerebrovascular , Trastornos de Deglución/etiología , Ingestión de Alimentos , Humanos , Masculino , Estado Nutricional , Accidente Cerebrovascular/complicaciones
3.
PLoS One ; 16(10): e0257910, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34597292

RESUMEN

BACKGROUND: The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied. Preliminary evidence suggests that the time from onset of symptoms to emergency department (ED) presentation has significantly increased in Covid-19 times as well as the 30-day mortality and in-hospital mortality. METHODS: We check, in a causal inference framework, the causal effect of the hospital's stress generated by Covid-19 pandemic on in-hospital mortality rates (primary end-point of the study) of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9th 2020) using two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs. Data are drawn from Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. FINDINGS: Despite the potential adverse effects on expected mortality due to a longer time to hospitalization and staff extra-burden generated by the first wave of Covid-19, the AMI and stroke mortality rates are overall not statistically different during the first wave of Covid-19 than before the first peak. The obtained results provided by RDD models are robust also when we account for seasonality and unobserved factors with DRD models. INTERPRETATION: The non-statistically significant impact on mortality rates for AMI and stroke patients provides evidence of the hospital ability to manage -with the implementation of a dual track organization- the simultaneous delivery of high-quality cares to both Covid and non-Covid patients.


Asunto(s)
COVID-19/patología , Infarto del Miocardio/mortalidad , Accidente Cerebrovascular/mortalidad , COVID-19/epidemiología , COVID-19/virología , Bases de Datos Factuales , Servicios Médicos de Urgencia , Mortalidad Hospitalaria , Hospitalización , Humanos , Italia/epidemiología , Infarto del Miocardio/patología , Pandemias , Estudios Retrospectivos , SARS-CoV-2/aislamiento & purificación , Accidente Cerebrovascular/patología
4.
Medicine (Baltimore) ; 100(40): e27396, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34622844

RESUMEN

BACKGROUND: Western medicine has played an essential role in treating poststroke insomnia (PSI) in China, and traditional Chinese medicine therapy based on Chinese characteristics is also effective. Combined with China's national conditions, we plan to conduct this systematic review and meta-analysis to compare the efficacy of integrated traditional Chinese medicine and Western medicine (INTEGRATED TCM and WM) therapy and Western medicine alone for PSI. METHODS: We will search the following 5 electronic databases: PubMed, Wanfang, Chinese biomedical literature database, the Chongqing VIP Chinese Science and Technology Periodical, and China national knowledge infrastructure. Randomized controlled trials that compared the efficacy of INTEGRATED TCM and WM with Western medicine alone in the treatment of PSI will be considered. Primary outcomes have Treatment effectiveness rate, and Pittsburgh sleep quality index. Secondary outcomes include traditional Chinese medicine syndrome score, Athens insomnia scale, the incidence of adverse reactions, and outcome follow-up. Based on the eligibility criteria, we will conduct literature screening and data extraction. The quality of the included literature will be evaluated using the Cochrane risk of bias tools. We will use Review Manager software (Version 5.3) for data synthesis and statistical analyses. If sources of heterogeneity exist, we will perform a subgroup analysis or sensitivity analysis. A funnel plot will be used to analyze publication bias. RESULTS: This study will provide evidence-based medicine evidence for treatment of PSI with INTEGRATED TCM and WM in terms of its efficacy. CONCLUSION: This systematic review aims to provide new options for INTEGRATED TCM and WM treatment of PSI in terms of its efficacy.


Asunto(s)
Medicina China Tradicional/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Accidente Cerebrovascular/complicaciones , Humanos , Metaanálisis como Asunto , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Revisiones Sistemáticas como Asunto
5.
Rev Fac Cien Med Univ Nac Cordoba ; 78(3): 264-269, 2021 08 24.
Artículo en Español | MEDLINE | ID: mdl-34617715

RESUMEN

Introduction: Sleep breathing disorders (SBD) especially obstructive hypopnea apnea syndrome (OSA) in patients with stroke are common and can complicate their evolution. The objective was analyzing the different sleep breathing disorders in patients with stroke. Methods: Descriptive, cross-sectional and retrospective study of acute ischemic stroke patients, using nightly polysomnography with oximetry (PSG). Results: It was a descriptive, cross-sectional, retrospective study during 19 months; 53 patients with stroke were included, with a men age of 67 ±12 years and 62% were men. SBD was evaluated by nocturnal polysomnography with oximetry within 10 days of installing the stroke. The Apnea hypopnea index (AHI) was 24.5±20, of mild grade in 21%, moderate in 31%, severe grade in 34%. The average oxygen saturation time less than 90% was 38 ±51 minutes. The minimum oxygen saturation was marked in infratentorial lesions. Conclusion: We found a high percentage of OSA, which was associated with older patients and a higher body mass index. There was a marked decrease in the minimum oxygen saturation and greater tendency to present central apneas in infratentorial lesion. Early diagnosis and treatment could minimize neuronal damage and improve prognosis.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Sueño
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(9): 1105-1113, 2021 Sep 06.
Artículo en Chino | MEDLINE | ID: mdl-34619929

RESUMEN

Objective: To investigate the risk factors of first recurrence in ischemic stroke patients at different periods after first attack. Methods: The subjects were from the screening population of China National Stroke Screening Survey (CNSSS) from 2013 to 2015. The basic demographic information, stroke history, influencing factors and modified Rankin Scale (mRs) scores were collected by using standardized face-to-face questionnaires. A case-control study was conducted to investigate the risk factors of first recurrence in ischemic stroke patients who relapsed for the first time within 12 months, 24 months and 36 months as the case group and non-recurrent ischemic stroke patients as the control group. Further, the subjects were stratified into different subgroups by age, gender and urban-rural distribution to investigate the risk factors of first recurrence in different periods. Results: Diabetes (OR=1.71, 95%CI: 1.08-2.71) and coronary heart disease (OR=1.55, 95%CI: 1.09-2.19) were significantly associated with the risk of first recurrence within 12 months after the first onset of ischemic stroke. The diabetes was significantly associated with the risk of first recurrence within 24 months (OR=1.94, 95%CI: 1.33-2.83) and 36 months (OR=1.64, 95%CI: 1.15-2.34) after the first onset of ischemic stroke. With the increase of mRs score, the risk of first recurrence within 12 months, 24 months and 36 months in ischemic stroke patients increased significantly. In the same period, the risk factors of ischemic stroke recurrence differed in patients with different age, gender and urban-rural distribution. Conclusions: The risk factors of first recurrence in ischemic stroke patients are diverse at different periods after the first onset of ischemic stroke. In different subgroups, the risk factors of first recurrence and the strength of its corresponding association are also different.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Estudios de Casos y Controles , Humanos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología
7.
Cent Eur J Public Health ; 29(3): 230-235, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34623124

RESUMEN

OBJECTIVE: The main goal of the study was to find out the general public's awareness of stroke, the relations between the awareness of stroke and socio-demographic factors, and awareness of stroke and experience of stroke. METHODS: The combination of a non-standardized questionnaire on the stroke prevention and a standardized questionnaire on the identification of the general health literacy (HLSQ-16) was used. The sample was chosen using a quota choice. The sample structure corresponded with the composition of the Czech population with regard to regions, sex and age. These features were determined as representative. The sample consisted of 1,004 respondents. RESULTS: The general awareness of stroke is high in the Czech Republic. Most of the respondents (97.2%) stated that they had ever heard of stroke. This basic awareness is influenced by the sex and marital status of the respondents. Almost one half (42.2%) of the general public would welcome more information on stroke. Women showed significantly higher interest in the information than men. Significantly higher interest could be seen in elderly respondents while younger respondents said significantly more frequently that they were not interested in the information. Married respondents showed a significantly higher degree of awareness. Rural respondents expressed higher interest in the information. The interest in the information dropped with higher education. The interest was significantly influenced by the respondents' sex, place of residence, marital status, and education. Almost 1/4 (24.3%) of respondents mentioned stroke incidence in their families. Our study proved that this incidence significantly varied in dependence on the respondents' sex, age, marital status and education. Further questions were focused on the sources of information on stroke. The most important sources include internet, which was named by nearly one half (48.6%) of respondents, and it was found that women could use the sources of information more frequently than men. Women used all sources of information on stroke (internet, television, families, GPs) more than men. CONCLUSION: The Czech respondents' interest in stroke is significantly influenced by their sex, age, place of residence, marital status, and the respondents' education. The findings play a role in the focus on preventive activities in this area. It is necessary to implement the general public education not only in general practitioners' offices but also in mass media in order to improve the awareness of stroke.


Asunto(s)
Alfabetización en Salud , Accidente Cerebrovascular , Anciano , República Checa/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Accidente Cerebrovascular/epidemiología , Encuestas y Cuestionarios
8.
Zhongguo Zhen Jiu ; 41(10): 1069-73, 2021 Oct 12.
Artículo en Chino | MEDLINE | ID: mdl-34628736

RESUMEN

OBJECTIVE: To verify the superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia in early stroke. METHODS: A total of 64 patients of stroke hemiplegia with upper limb flaccid paralysis were randomly divided into an observation group (32 cases, 1 case dropped off ) and a control group (32 cases, 4 cases dropped off ). The observation group was treated with motor imagery acupuncture (both acupuncture and motor imagery therapy at affected upper limb were performed).The control group was treated with acupuncture plus motor imagery therapy at affected lower limb, 2 h later after acupuncture, motor imagery therapy was applied to upper limb. Baihui (GV 20) to Taiyang (EX-HN 5) of healthy side, Fengchi (GB 20) and Jianyu (LI 15), Jianjing (GB 21), Quchi (LI 11), Waiguan (TE 5) on the affected side, ect. were selected in both groups, once a day, 5 times a week for 4 weeks. Before and after treatment, 4, 8 weeks after treatment, the modified Ashworth scale (MAS) grade and Brunnstrom stage were compared in the two groups. RESULTS: Compared before treatment, the muscle tension of shoulder, elbow and wrist each time point after treatment was increased in the two groups (P<0.05). After treatment, the proportion less than grade Ⅱ of elbow MAS grade in the observation group was higher than the control group (P<0.05); 4 and 8 weeks after treatment, the proportion less than grade Ⅱ of shoulder, elbow and wrist MAS grades in the observation group was higher than the control group (P<0.01). The Brunnstrom stage of arm and hand each time point after treatment was higher than the previous time point in the two groups (P<0.05), those in the observation group was higher than the control group (P<0.05). CONCLUSION: Motor imagery acupuncture could promote hemiplegia upper limb muscle tension recovery in patients of stroke hemiplegia with upper limb flaccid paralysis, make the patients gradually shift to the separate fine movement mode, inhibit and relieve the appearance and development of spasm.


Asunto(s)
Terapia por Acupuntura , Accidente Cerebrovascular , Hemiplejía/etiología , Hemiplejía/terapia , Humanos , Tono Muscular , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Resultado del Tratamiento , Extremidad Superior
9.
Zhongguo Zhen Jiu ; 41(10): 1084-8, 2021 Oct 12.
Artículo en Chino | MEDLINE | ID: mdl-34628739

RESUMEN

OBJECTIVE: To observe the efficacy difference between conventional needling depth and deep needling for dyspepsia after ischemic stroke. METHODS: A total of 120 patients with dyspepsia after ischemic stroke were randomized into an observation group (60 cases, 4 cases dropped off) and a control group (60 cases, 3 cases dropped off). Basic treatment was given in the both groups. In the observation group, deep needling was applied at Zhongwan (CV 12), Tianshu (ST 25) and Liangmen (ST 21) for 60-70 mm, after even reinforcing-reducing manipulation of lifting-thrusting technique, the needles were withdrew to 35-50 mm. In the control group, the same acupoints as the observation group were selected and punctured for 25 mm. The needles were retained for 30 min, once a day, 6 times a week for 2 weeks in the both groups. The dyspepsia TCM symptom score was observed before treatment, 1 day and 1, 2 weeks into treatment, and the clinical efficacy was evaluated 2 weeks into treatment in the both groups. RESULTS: The effective rate was 92.9% (52/56) in the observation group, which was superior to 78.9% (45/57) in the control group (P<0.01). Compared before treatment, the total scores and sub-item scores of dyspepsia TCM symptom of 1, 2 weeks into treatment were decreased in the both groups (P<0.01, P<0.05). The total scores and abdominal fullness scores of dyspepsia TCM symptom of each time point into treatment and hiccup score of 2 weeks into treatment in the observation group were lower than those in the control group (P<0.01, P<0.05). The total scores of dyspepsia TCM symptom 1, 2 weeks into treatment in the mild patients and each time point into treatment in the moderate patients of the observation group were lower than those in the control group (P<0.01). CONCLUSION: Conventional needling depth and deep needling can both improve the clinical symptoms in patients with dyspepsia after ischemic stroke, and deep needling has faster and better efficacy.


Asunto(s)
Terapia por Acupuntura , Isquemia Encefálica , Dispepsia , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Dispepsia/terapia , Humanos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia
10.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(5): 507-511, 2021 Sep 30.
Artículo en Chino | MEDLINE | ID: mdl-34628762

RESUMEN

A 3D printing based wrist orthosis device was developed. After collecting the contour information of the carpal and metacarpophalangeal joints of the patients with a 3D scanner, the wrist orthotics were designed to meet the individual needs of the patients according to the relevant requirements of biomechanics. Choose TPU (thermoplastic polyurethanes) materials for preparation of 3D printing. It can functionally assist the smart brace after stroke patients with hemiplegia early rehabilitation training, the use of orthoses carry MPU6050 inertial sensor, magnetometer, time module device such as a sensor and monitor its movements and record the training time, ensure safe efficient rehabilitation training, help patients return to a normal life as soon as possible.


Asunto(s)
Accidente Cerebrovascular , Muñeca , Humanos , Aparatos Ortopédicos , Impresión Tridimensional , Articulación de la Muñeca
11.
Ann Palliat Med ; 10(9): 9435-9442, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34628869

RESUMEN

BACKGROUND: The increasingly younger age of stroke onset has posed a serious threat to the physical and mental health of young and middle-aged adults. Young and middle-aged stroke patients often suffer from varying degrees of motor, cognitive, and language disabilities, which can trigger considerable psychological trauma. However, these patients may have certain posttraumatic growth (PTG). As a positive psychological experience, PTG provides a new entry point for clinical psychological interventions. Here, we explored the trajectories of PTG in young and middle-aged stroke patients and their predictive effects on mental health. METHODS: A total of in 165 patients who were treated at our center from January to December 2019 were enrolled with randomized sampling. The survey was conducted at 5 times follow up through use of the Posttraumatic Growth Inventory (PTGI), Social Support Rating Scale (SSRS), and Symptom Checklist-90 (SCL-90). Data were analyzed by using the latent growth mixture modeling (LGMM). RESULTS: The PTG levels in young and middle-aged stroke patients showed a gradual increase (F=9.927; P<0.01). According to the relevant parameters of the trajectories, the subjects were divided into the high PTG group (n=43, 26.06%), low PTG group (n=25, 15.15%), rapidly increasing PTG group (n=47, 28.48%), and constantly decreasing PTG group (n=50 cases, 30.30%). Both the initial level and developmental rate of PTG had significantly negative predictive effects on SCL-90 score (B=-0.46, P<0.01; B=-0.31, P<0.01); in other words, they had positive predictive effects on mental health. CONCLUSIONS: There are different trajectories of PTG in young and middle-aged stroke patients, and the initial level and developmental speed of PTG have positive predictive effects on mental health in these patients.


Asunto(s)
Crecimiento Psicológico Postraumático , Accidente Cerebrovascular , Adaptación Psicológica , Adulto , Humanos , Salud Mental , Persona de Mediana Edad , Apoyo Social
12.
Ann Palliat Med ; 10(9): 9523-9534, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34628878

RESUMEN

BACKGROUND: Due to constantly emerging new studies on Xuesaitong injection (XST) agent, it is necessary to summarize and analyze the latest published clinical research data to re-evaluate the clinical efficacy and safety of XST. This study mainly aimed to evaluate the clinical efficacy and safety of XST combined with western medicines (WM) for ischemic stroke treatment. METHODS: The related databases were searched to collect all randomized controlled trials (RCTs) comparing the combination of XST and WM with WM alone for the treatment of patients with ischemic stroke. Participant, intervention, comparison, outcome and study type (PICOS) was the inclusion criteria of all studies. The search for and data extraction of the included studies was performed by 2 researchers, who then conducted quality evaluation. The Cochrane Collaboration's risk of bias tool was used for the article evaluation. The software RevMan 5.3 and Stata 15.0 were used for pooled analysis. RESULTS: A total of 12 RCTs were included involving 1,769 patients with ischemic stroke, which combined XST with WM therapy. Moreover, the funnel plot showed that there was no obvious publication bias in the included studies. Meta-analysis showed that the total effective rate in the XST combined with WM group was higher than that in the WM alone group [odds ratio (OR) =4.04, 95% confidence interval (CI): 2.86 to 5.73, P<0.001]. The National Institutes of Health Stroke Scale (NIHSS) score in the XST combined with WM group was significantly lower than that in the WM alone group [weighted mean difference (WMD) =-3.17, 95% CI: -4.14 to -2.20, P<0.001]. In addition, XST combined with WM significantly reduced the plasma viscosity, fibrinogen level, whole blood high shear viscosity, and whole blood low shear viscosity in patients with ischemic stroke (P<0.01). For the comparison of adverse reactions, the results showed that the adverse reactions among patients with ischemic stroke in the XST combined with WM group and in the WM group did not differ significantly. DISCUSSION: Compared with single WM medication, XST combined with WM improves the total clinical effective rate, promotes the recovery of patients' neurological function, and has few adverse reactions and high safety in clinical application.


Asunto(s)
Medicamentos Herbarios Chinos , Accidente Cerebrovascular Isquémico , Saponinas , Accidente Cerebrovascular , Medicamentos Herbarios Chinos/efectos adversos , Humanos , Accidente Cerebrovascular/tratamiento farmacológico , Estados Unidos
13.
Pan Afr Med J ; 39: 212, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34630824

RESUMEN

Introduction: left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. The objective was to determine the etiology, treatment practices, rate of resolution and clinical outcomes in patients with LVT in the region. Methods: a review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes. Results: during the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88 (88%) patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post myocardial infarction (MI) in 28 (28%), chronic ischemic cardiomyopathy in 42(42%) and non-ischemic cardiomyopathy in 30 (30%) patients. In 15 (15%) patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 (92%) patients. Among these, 34 (37%) received warfarin while 58 (63%) were treated with a DOAC. In the 64 patients who had reassessment imaging (median duration 177 days), complete thrombus resolution was noted in 38 (59.4%). One-year clinical outcome data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had had a bleeding episode. Rates of thrombus resolution (warfarin 64%, DOAC 55.6%, p=0.51), stroke (warfarin 2.9%, DOAC 1.7%, p=1.0) and bleeding (warfarin 5.9%, DOAC 5.2%, p = 1.00 were not significantly different among patients treated with warfarin and DOAC. Conclusion: we noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.


Asunto(s)
Anticoagulantes/administración & dosificación , Trombosis/tratamiento farmacológico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Warfarina/administración & dosificación , Adulto , Anciano , Anticoagulantes/efectos adversos , Ecocardiografía , Femenino , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Kenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Trombosis/diagnóstico por imagen , Trombosis/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Warfarina/efectos adversos
14.
Neurologia (Engl Ed) ; 36(8): 577-583, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34654531

RESUMEN

INTRODUCTION: The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS: Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS: Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS: The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Lenguaje , Reproducibilidad de los Resultados , Traducciones
15.
Neurologia (Engl Ed) ; 36(8): 589-596, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34654533

RESUMEN

INTRODUCTION: Haemorrhagic transformation is a major complication of acute ischaemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial haemorrhage (ICH) after revascularisation therapy. METHODS: We conducted a retrospective, single-centre study including 235 patients with AIS who underwent intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy and/or endovascular treatment. A binary logistic regression model was used to determine the variables associated with ICH, parenchymal haematomas (PH), modified Rankin Scale (mRS) scores, and mortality. RESULTS: ICH was detected in 57 (30 with PH) of 183 patients included. Mechanical thrombectomy, either alone (OR 3.3 [1.42-7.63], P=.005) or in combination with IV-rtPA (OR 3.39 [1.52-7.56], P=.003), was associated with higher risk of ICH, while higher Alberta Stroke Program Early CT scores (OR 0.71 [0.55-0.91], P=.007) were associated with lower risk. Patients with older age (OR 1.07 [1.02-1.13], P=.006) and occlusion of the terminal branch of the internal carotid artery (OR 4.03 [1.35-11.99], P=.012) had a higher risk of PH, while the use of IV-rtPA alone (OR 0.24 [0.08-0.68], P=.008) was associated with lower risk of PH. Only PH was associated with disability as measured by the mRS (OR 3.2 [1.17-8.76], P=.02) and higher mortality (OR 5.06 [1.65-15.5], P=.005). CONCLUSIONS: Greater understanding about the predictors of ICH, mRS scores, and mortality could enable better selection of patients and treatments.


Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular , Anciano , Isquemia Encefálica/epidemiología , Procedimientos Endovasculares/efectos adversos , Humanos , Incidencia , Pronóstico , Estudios Retrospectivos , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento
16.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(9): 1426-1430, 2021 Aug 31.
Artículo en Chino | MEDLINE | ID: mdl-34658360

RESUMEN

OBJECTIVE: To investigate the clinical efficacy and safety of intravenous thrombolysis in patients with acute severe cerebral infarction and analyze the risk factors of poor prognosis after thrombolysis. METHODS: This randomized controlled trial was conducted among 152 patients with acute severe cerebral infarction, with the onset time all within 4.5 h. The patients were randomized into control group (76 cases) and observation group (76 cases) and received treatment with routine therapy (antiplatelet aggregation, statins, neuroprotection and drugs that stimulate blood flow) and intravenous thrombolytic therapy with alteplase in addition to the routine therapy, respectively. The NIHSS scores were recorded at 24 h, 1 week and 1 month after the treatment. The mRS scores at 3 months and the incidence of symptomatic intracranial hemorrhage at one week after the treatment were compared between the two groups. According to mRS scores at 3 months, the patients in the observation group were divided into good prognosis group (30 patients) and poor prognosis group (46 patients), and the risk factors for poor prognosis were analyzed using univariate and multivariate Logistic regression analysis. RESULTS: At 24 h, 1 week and 1 month after the treatment, the reduction of NIHSS scores was more significant in the observation group than in the control group (F=24.684, P < 0.001). At 3 months after the treatment, the mRS scores were significantly lower (t=4.396, P < 0.001) and the good prognosis rate was significantly higher (χ2=13.636, P < 0.001) in the observation group than those of the control group. Symptomatic intracranial hemorrhage occurred in 4 cases in the observation group and in 2 cases in the control group within 1 week after the treatment (χ2=0.694, P=0.405). The time from onset to thrombolysis (OR=0.173, P=0.035), prethrombolytic systolic pressure (OR=0.869, P=0.019) and baseline NIHSS score (OR=0.466, P=0.011) were identified as independent risk factors for poor prognosis after intravenous thrombolysis. CONCLUSION: Intravenous thrombolysis is effective and safe for patients with acute severe cerebral infarction, and the time from onset to thrombolysis, prethrombolytic systolic pressure and baseline NIHSS score are independent risk factors for a poor prognosis after intravenous thrombolysis.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Infarto Cerebral/tratamiento farmacológico , Humanos , Factores de Riesgo , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica
18.
BMC Neurol ; 21(1): 380, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34600504

RESUMEN

BACKGROUND: Stroke is a crucial health threat to adults worldwide. Despite extensive knowledge of risk-factor mitigation, no primary prevention exists for healthy people. Coffee is a widely consumed beverage globally. Health benefit of coffee for several neurological diseases has been identified; however, the association between stroke risk and coffee consumption in healthy people has not been determined. We investigated the effect of coffee on stroke risk by conducting a meta-analysis of prospective cohort studies. METHODS: Electronic databases, namely PubMed, BioMed Central, Medline, and Google Scholar, were searched using terms related to stroke and coffee. Articles that described clear diagnostic criteria for stroke and details on coffee consumption were included. The reference lists of relevant articles were reviewed to identify eligible studies not shortlisted using these terms. Enrolled studies were grouped into three outcome categories: overall stroke, hemorrhagic stroke, and ischemic stroke. RESULTS: Seven studies were included and all of them were large-scale, long-term, follow-up cohort studies of a healthy population. Upon comparing the least-coffee-consuming groups from each study, the meta-analysis revealed a reduction in the risk of overall stroke during follow-up (hazard ratio [HR] for overall stroke = 0.922, 95% confidence interval [CI] = 0.855-0.994, P = 0.035). In studies with a clear definition of hemorrhagic and ischemic stroke, coffee consumption reduced the risk of ischemic stroke more robustly than that of hemorrhagic stroke (hemorrhagic, HR = 0.895, 95% CI = 0.824-0.972, P = .008; ischemic, HR = 0.834, 95% CI = 0.739-0.876, P < .001). No obvious dose-dependent or U-shaped effect was observed. CONCLUSIONS: Coffee consumption reduces the risk of overall stroke, especially ischemic stroke. Further investigation is required to identify beneficial components in coffee, including caffeine and phenolic acids, to develop preventive medication for stroke.


Asunto(s)
Café , Accidente Cerebrovascular , Adulto , Estudios de Cohortes , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología
19.
BMC Neurol ; 21(1): 385, 2021 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-34607563

RESUMEN

BACKGROUND: Large artery atherosclerotic disease is an important cause of stroke, accounting for 15-46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke. METHODS: We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50-69%) or severe (70-99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis. RESULTS: A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations. CONCLUSIONS: Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.


Asunto(s)
Isquemia Encefálica , Estenosis Carotídea , Endarterectomía Carotidea , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología
20.
BMC Neurol ; 21(1): 383, 2021 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-34607565

RESUMEN

BACKGROUND: Fasting C-peptide (FCP) has been shown to play an important role in the pathophysiology of mood disorders including depression and schizophrenia, but it is unknown whether it also predicts post-stroke depression (PSD). This study examined the association between FCP and PSD at 6 months after acute ischemic-stroke onset among Chinese subjects. METHODS: A total of 656 stroke patients were consecutively recruited from three hospitals of Wuhan city, Hubei province. Clinical and laboratory data were collected on admission. PSD status was evaluated by DSM-V criteria and 17-item Hamilton Rating Scale for Depression (HAMD-17) at 6 months after acute ischemic stroke. The χ2-test, Mann-Whitney U-test, and t-test were used to check for statistical significance. Multivariate logistic regression model was used to explore independent predictor of PSD. RESULTS: In the univariate analysis, significant differences were found between the PSD and non-PSD groups in terms of FCP level (p = 0.009). After multivariate adjustments, FCP remained a significant independent predictor of PSD, with an adjusted odds ratio of 1.179 (95%CI: 1.040-1.337, p = 0.010). CONCLUSIONS: Higher FCP levels on admission were found to be associated with PSD at 6 months after acute ischemic-stroke onset. For stroke patients, doctors should pay attention to the baseline FCP for screening high-risk PSD in clinical practice.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Isquemia Encefálica/complicaciones , Isquemia Encefálica/epidemiología , Péptido C , Depresión/epidemiología , Depresión/etiología , Ayuno , Humanos , Estudios Prospectivos , Accidente Cerebrovascular/complicaciones
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